Healthcare Provider Details

I. General information

NPI: 1730244138
Provider Name (Legal Business Name): JALAINE R FISHELL MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 2ND ST SUITE C
ODESSA MO
64076-1137
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 816-633-5921
  • Fax: 816-633-7942
Mailing address:
  • Phone: 660-885-8131
  • Fax: 660-885-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2006036525
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: